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Saturday, March 6, 2010

MiM Mailbag: Self-entitled?

Editorial note: We received an anonymous comment this past week to a post that was published about a year ago on this blog (Fizzy's I hate boys). I debated whether or not to publish this as a MiM Mailbag since it has the potential to become an inflammatory discussion that would ultimately not be constructive. However, the comment presents challenging views that many women face when having children during training (and sometimes beyond); a thoughtful and respectful discussion about the issues raised could further understanding by all. So, feel free to join in, but please keep comments constructive and respectful so we can have an intelligent discussion. Thanks.

I am not really sure why all of you self-entitled people in medical school and residency, think that it is actually an acceptable time to be having children at all.

Your absence put a huge burden on the remainder of your class, and your constant need to leave early to "be with the kids", "take care of sick kids", etc. just highlights the fact that maybe you should have chosen a career more inline with what you percieve to be an ideal life - like being a PA, nurse, etc.

The ultimate problem lies in the people who seems to "want it all", but feel they are "special" and don't need to sacrifice anything. Because some of us don't want children doesn't mean that we should supercompensate for those that do. Not everyone was meant to be a doctor, and if other people started using similar excuses in would certainly raise eyebrows - eg: I NEED to go on frequent climbing trips because it is consistent with my world view of life and you OWE it to me.

Basically just entitlement by another name, but not overly surprising in this society.

23 comments:

Ironically, my original post was complaining about how a lot of male residents are kind of unreliable. The resident I had been writing about in particular was a single male resident who was only assigned clinic in the morning, but the afternoon clinic was double-booked for some reason, and I was the only resident assigned to do it. The attending asked if he could help out for just an hour or two, and he said he couldn't because..... he was going to look at cars. I think my mouth fell open when I heard that one.

In fact, I spent most of that rotation covering for guys who were not running home to kids, but rather were flying all over the country to interview for prestigious fellowships. (Because I didn't want to be away from my daughter, I skipped out on the interviews and the conferences.) A few women in my residency took short maternity leaves, but the longest leave by far was taken by a *man*... six months of family leave. (Very understandable considering the circumstances, but I must point it out.)

I do think there are women out there who are kind of pigs and will use their kids as an excuse to be totally unreliable. But that's part of the premorbid personality. Guys do it too, they just come up with other excuses.

And if we're going to unfairly generalize by sex, we could also point out that women tend to be healthier later in life. So while there might be 4-5 months total of maternity leave early in their 40 year career (seems insignificant when you put it that way), presumably they'll be healthier and need less leave later.

Finally, I think the person who wrote that comment is a resident who had to do some coverage for a woman on maternity leave. Otherwise, they would recognize that med school and residency is probably a better time to have a child than in private practice, since the level of responsibility is lower and the number of people available to cover is higher. As a resident, I had 20 people to distribute my work when I was gone. As an attending, there will only be a couple of people to share the burden.

Sure it's tough when another resident leaves the program (for any reason). It stinks while they are gone but most of the moms in my program (including me) work extremely hard to keep our kids from "interfering" with our career. The one person who had a child this year will also make up her missed calls.

I know that I have bent over backwards, finagled every manner of childcare coverage and for the first time last weekend had an hour and a half between when I got off call and my husband was at work that I could not get anyone to watch my daughter. I tried to switch calls to no avail and in the end did have to ask to get off call at 530 am instead of 7. Did I feel bad? Of course, I didn't want to seem unreliable but at same time, I have never called out sick or missed a day of work for any other reason. Life occasionally gets in the way. It's too short to keep score.

there is never a perfect time to have a baby, plain and simple. there is always someone that is going to have to pick up the slack and cover when you are off for a short or long while. i agree with fizzy in the statement that having a baby in residency spreads coverage over many more available people than in private practice. i had my first during my second year of residency, taking 4 months maternity leave, splitting my call amount among about 28 people (essentially 1 extra call per every other person). then, i had my second baby in practice, and granted i am in a big practice with 9 pediatricians, one other pediatrician happened to have a baby the same time i did. it was much more of an issue for coverage. a lot of my regular patients did not get seen, had less priority, and my location was closed a number of days making even work for my nurse and receptionist less. i felt obligated to return after 12 weeks just to reduce the burden to my partners and the inconvenience to my patients, and my partner returned after 8 weeks for the same reason. so, all in all- even if there isnt a *perfect* time to have a baby, residency is a *pretty darn good* time.

I'm not sure I understand how wanting to be a doctor AND wanting kids is "wanting it all." It just sounds like "wanting a nice life" to me.

As for covering your colleagues during residency, don't know what else to say but s*** happens. People get sick, their lives change, they acquire commitments they didn't anticipate. What would happen if a resident's parent became ill and died during residency, or needed care for a few months? What if a resident got cancer? I really think residency programs ought to be planning for these sorts of contingencies. I do understand the resentment from colleagues when they feel they are doing all the covering and feel like they're getting nothing back. At the same time, I also believe that everyone ultimately does get paid back. In karma if nothing else.

The difference between dealing with an illness and a pregnancy as a colleague is that one is a choice and the other isn't.

It's difficult because medicine (like many other fields) was long organized to depend on the unpaid labor of women, primarily doctor's wives. Women rarely have access to the unpaid labor of someone willing to raise their kids, cook, clean, etc. We're in the midst of economic reorganization, and it's not easy at all.

I got a comment from a co-resident when I was pregnant with my daughter, 2nd year resident, on clinical pathology rotations. "How nice you are about to get a eight week vacation." He was jealous. Of maternity leave? I thought later, when I was feeling like I had been stuck in a rabbit hole and the light was so far away and I couldn't figure out how to get out. All of the newness -- pumping, feeding, schedules (or lack thereof), up all night - d***, I was ready to get back to work so I could have a break!

Now I communicate with that guy and he helps me out with blood bank issues - he did a fellowship and is the director of the Red Cross in my town. He's a really great guy. I think people get so wrapped up in the stress they are going through they don't think about it from another angle. Sometimes, they get angry and inflammatory and they hold on to that s*** for the rest of their lives. I feel sorry for them.

I agree with Fizzy and all above. Both men and women can come up with excuses to shirk their duties, and unfortunately it does happen with kids. I've seen male and female doctors get angry about this. But I've also seen the same male and female doctors celebrate and appreciate women who work hard, do a good job, and have kids during residency. I can proudly say that I fell into that category, and I can tell a lot of the women on this blog probably did, too.

I have a lot of trouble with the argument that "pregnancy is a choice so it is different." I know a resident who got pregnant while on birth control pills, so obviously it's not always a choice.

Furthermore, a lot of choices we make affect our health. If you choose to smoke and you get cancer or heart disease from that, then should you be denied a leave? If you eat poorly, gain weight, and have a heart attack, should you be denied a leave when you need bypass surgery? What if you choose to drive too fast and get into a car accident? Ultimately, many things are a choice and it's a slippery slope to use that argument.

I think everyone here is missing the real issue. The issue is that people don't like being taken advantage of by their co-workers, and they don't like working with slackers and flakes. And parent or not, many people fall into this category. I feel just as abused by a flakey co-worker who has a daily emergency related to their commute, their dog, they locked themselves out of their car, their tummy hurts, etc. as I feel by a parent-co-worker who constantly uses their children as an excuse to flake out. That being said, its the flakiness that sucks, not the child emergencies. There are plenty of parent-physicians who are 100% reliable and don't dump their work on others. I don't know anyone who has a problem with parent physicians who put in their fair share of the work and who occasionally have child emergencies and need co-workers to cover.... like every other Joe Physician.

Might I remind the author of the original comment, we are all human beings. No matter how hard you want to believe that you, as a Doctor, are not. The truth is whether it is climbing or mothering or any other part of our lives that keep us human; this is what makes us a good physician. What a patient really wants is a care provider with enough perspective to realize that life is messy and that we all have to work to balance it. I suspect that someday the author will realize that he too is also susceptible to life.

I agree with the above comments. It's often that physician-moms have that little something extra to prove to our colleagues. I certainly try to go out of my way to make sure that I have adequate child care coverage and that my colleagues do not become burdened by my choice to have a family (which has incidently kept me more sane and happy than the rest of my co-interns at this point in the year). Obviously, the original poster has never had kids - as they point out that we (physician-moms) don't want to sacrifice anything for this ideal life. Ironic, because I feel like all I do is sacrifice. Sometimes I sacrifice being the "best intern possible" by not reading as much as I should at home, and sometimes I sacrifice my family for work. I don't get a pat on the back for missing my child's first christmas because I was on call in the ICU. I showed up and did my job, because it's the right thing to do.

I always find it a bit laughable when people say, "be a PA or a nurse" if you want a family, etc. It's just as hard to take maternity leave, get coverage for unplanned emergencies, etc if you work in one of those fields. People still depend on you, patients need rescheduled or seen by someone else. I think anyone who wants a career and a family has to find a way to balance both, while minimizing the impact that each has on the other. It's tough!!

"It's difficult because medicine (like many other fields) was long organized to depend on the unpaid labor of women, primarily doctor's wives. Women rarely have access to the unpaid labor of someone willing to raise their kids, cook, clean, etc. We're in the midst of economic reorganization, and it's not easy at all."

Anon, I think this is a really really good point. Men with families have traditionally been able also have careers because they rely on women's unpaid work. The world is structured such that the expectation in many fields is that you don't need to deal with your kids or have time to buy groceries, or clean your house or go to the bank, because you should have someone else to do it for you. As the division of labor shifts, as it rightfully should, those burdens are something that both men and women will have to learn to juggle. (Or, in a perfect world, something that workplaces will need to accommodate). Right now the burden is heavier on women, because while so many of us are in the workplace, housework and child care has been super slow to shift off our our backs.

I'm not in the medical community and I'm not a parent, though I am considering both. I do think I can share a broader sociological perspective.

Women have entered every part of the work force and that's not going to change. In fact, it has become a necessity for individual families and for whole economies. The idea that one profession is going to be an exception is unrealistic. As a woman I appreciate seeing female doctors and I don't really care if the presence of my female doctor in the profession has somehow inconvenienced her colleagues. Given fifty percent of patients are women, I'm thinking that's a pretty good reason to have at least a decent proportion of doctors be women. And there are really important economic and societal reasons those women should also be parents.

Interestingly enough, in countries that don't have public policy or values to support working mothers, women are having fewer children. This is in fact a much bigger burden on those societies than the inconveniences of a few sick days or even an extended maternity leave. I'm thinking of Japan, Singapore, Italy and really much of Western Europe. The fact is having children is not a selfish pursuit. Birthrates drive economies and reinvigorate cultures. A woman doctor who is also a mother is providing far more social good in both those roles than she would be if she were not mother or not a doctor. (Not there is anything wrong with choosing not to have children on an individual basis - but problems do arise when as many as 30% of women make this choice - see Germany.)

I have resented the seasonal colds, endless fundraising order forms and flimsy excuses that sometimes accompany working parent colleagues into the workplace - but I also try to have a little perspective. It seems to me a man in any profession should be able to muster a bit more tolerance since it's his wife who more often than not makes it possible for him to have it all.

This whole discussion is another reason why I am glad I had my children before medical school - crazy as it seems. Pregnancy is hard for me and so is the postpartum weeks - so I am glad that I didn't have to put that on anyone (except my husband). Like someone else said - there is never a good time to have children.

I do agree with OP about not using children as an excuse for your work ethic. But, in all honesty - the OP does seem to have a fight to pick and I think most reasonable people without children can handle most reasonable needs of people with children. When I say reasonable - I mean reasonable. When my children are sick, I have plans in place for their care so that I am not pulled away from school. Now, if there were an emergency situation, I think most people would understand that as long as it does not happen often.

Enjoying reading this discussion. Anonymous from 8:08 pm, thank you for that broader sociological perspective.

For me, I found the OP's comment disconcerting- mainly because presumably, this is coming from someone who has trained or is training to be in the medical profession. I hope what drives people into medicine as a career is a true desire to help others, to support patients and families: to care. I'm wondering what it's says about our profession when we can't support our own colleagues. Does being humanistic only apply to patients? Shouldn't it extend to the professionals we work alongside with?

"I always find it a bit laughable when people say, "be a PA or a nurse" if you want a family, etc. It's just as hard to take maternity leave, get coverage for unplanned emergencies, etc if you work in one of those fields."

Well put. And I think you'd be hard pressed to find a woman that finds maternity leave to be some fantastic vacation. The toll pregnancy takes on my body is no laughing matter, and that doesn't even take into account managing a newborn.

Interestingly, of all the doctors I have contact with (and there are many), I can think of more male doctors that have excessive vacation schedules than female doctors that are regularly pulled away for family issues.

I actually did choose nursing over doctoring largely because of the lifestyle, but also because I love what I do and have wanted to be a nurse since I was a preschooler. As my kids get older, I fully intend to go back to school for my DNP, which will put me back in the workplace much more than I am now, but it will be in a season that's better for my family. When to have kids is a very personal decision and I think the world would be a happier place if people would kindly mind their own beeswax.

I can't speak to Japan, Asia, etc, but in Italy, it's not the lack of pro-natalist policies that is causing women to have fewer children. In fact, women get 6-12 months guaranteed leave of absence from work when they have babies. The problem is that this had led to many companies refusing to hire women of childbearing age at all, so between that and the general sexism in Italy, many women decide that working is too much of a hassle.

The birth rates have gone down because it's impossible to find a job to support yourself (let alone your family) in your 20s. People (my brother-in-law is a case in point) live at home with their parents until they are in their 30s. They don't have multiple children because they can't afford to.

I had my son during the third year of my neurosurgical residency. To avoid putting undue burdens on my colleagues, I scheduled only 6 wks of maternity leave - during my 4 month neurology elective (during which we took no call). This ensured that I would not miss a day of call. And I didn't, not a single day, up through my scheduled last day of work on the neurotrauma service - at 38 wks.

Despite this, my male "colleagues" took bets on how many days I would miss. One of them went to the chairman and demanded I be made to make up any days I might miss due to the pregnancy. (The next year, he was out for 6 wks with a ruptured disc - and didn't make up any of the days we all covered for him.) Then, they made my last 6 months of residency miserable because they were angry at another female resident for taking time off to have a baby. This, despite my never asking for any help and never missing a day of work.

I don't see women who want children as being the problem here. The problem is self-centered people, male or female, who won't lift a finger to help someone else. Wait until you need help yourself, original poster - everybody does eventually - and see how it feels. And see who's willing to step up for you.

Further, most colleagues are not aware of the things done behind the scenes to keep them from being inconvenienced. My partners have no idea how many times I stay late to admit an ER patient or see a consult on their call day because I happened to still be there at 5:05. I don't notify them every time I answer a question from the floor nurses when I'm rounding in the evening after a late surgery, preventing them from getting paged. They don't know how many times I've canceled a night out or left for vacation a day late to take care of a complication on one of my patients that otherwise they (on call) would have to deal with.

Yes, many of your colleagues likely do things like this behind the scenes for you and just never tell you about it. It may appear sometimes that they are inconveniencing you by asking for help when they really need it. I guarantee, though, you'd be a lot more inconvenienced more regularly if they quit doing little things every day that you don't know about.

People need to quit whining and start treating their colleagues with the respect they deserve!

Wow, sounds like someone wandered over here from studentdoctor.net. I had to reply to a comment there that told all mothers to find a sugar daddy and give up on their selfish dreams of a medical career.

I love Fizzy's response. I can't tell you how much more productive and involved with medical school I have been than most of my childless classmates.

I think work ethic is work ethic, and blaming mothers for hypothetical poor work performance is a convenient way to be misogynistic. No one says fathers shouldn't go to medical school. Maternity leave is a small part of parenting, and most men want to take FMLA when they have a baby, now, too. It's not unique to mothers to care for a family member. Most classmates I know who have had problems academically due to a family member, it's been a sick parent.

70% of mothers are in the workforce. It's time to make this work better, not to point at us and tell us to limit our choices. It's not just doctors' coworkers who are affected by people who miss days. My husband is a teacher, and his work is valuable. No one told him he was privileged to get an education degree and still want to be a father, but he is the only one who can do his job that day, and it's quite an ordeal to hire substitutes.

Many professions involve parents, and all parents deserve support and respect (and options!), not just us important doctor types.

Wow, sounds like someone wandered over here from studentdoctor.net. I had to reply to a comment there that told all mothers to find a sugar daddy and give up on their selfish dreams of a medical career.

I love Fizzy's response. I can't tell you how much more productive and involved with medical school I have been than most of my childless classmates.

I think work ethic is work ethic, and blaming mothers for hypothetical poor work performance is a convenient way to be misogynistic. No one says fathers shouldn't go to medical school. Maternity leave is a small part of parenting, and most men want to take FMLA when they have a baby, now, too. It's not unique to mothers to care for a family member. Most classmates I know who have had problems academically due to a family member, it's been a sick parent.

70% of mothers are in the workforce. It's time to make this work better, not to point at us and tell us to limit our choices. It's not just doctors' coworkers who are affected by people who miss days. My husband is a teacher, and his work is valuable. No one told him he was privileged to get an education degree and still want to be a father, but he is the only one who can do his job that day, and it's quite an ordeal to hire substitutes.

Many professions involve parents, and all parents deserve support and respect (and options!), not just us important doctor types.

>>I really think residency programs ought to be planning for these sorts of contingencies.>>

I agree with OMDG. For a program to plan ahead is a logical, fair approach - life happens.

And, as I told a veterinary school hopeful just this weekend, it's equally important for the budding doctor to plan ahead. One of my friends had a baby two days after finishing 3rd year finals - it worked for her. But most of my classmates didn't have children until starting either residency or private practice. That required more juggling, especially for those sharing emergency call with only one or two other veterinarians or when two married veterinarians practice together. It's miserable to be on call 100% while a colleague takes time off from practice, for whatever reason.

First of all. I want tosay I am a single, childless ob/gyn who greatly enjoys reading this blog. Someday I hope to be a "Mom in Medicine." I have nothing but respect for women who juggle busy careers and then go home for the "second shift".

During med school and residency I never encountered a parent colleague who expected preferential treatment to take care of their childcare responsibilities. Private practice has been a WHOLE nother ballgame.

One of the reasons I left my group was due to the sense of entitlement my female partner had. She actually told me, with a straight face, that as the new person I should expect to work more holidays than the other 2 MDs. During one of our rare Southern snow days, she breezed thru L&D complaining how she had "to scramble" to go pick up her child and expected people to pity her! She said this while surrounded by upteen female nurses who also had to figure out how to pick up their kids, without the benefit of a 2 doctor household. Her selfishness/insensitivty had nothing to do with being a mom, but rather a character flaw.

I have no problem with parents who need help every now and then. I want someone to help me when I need to leave to go check on my parents or if I have some activity I want to participate in.

I am a mom who is in medical school- and I am truly tirec of apologizing for having children! I feel guilty if my kid is sick, my baby sitters have both backed out - but then my classmates misses lab to go to a CONCERT, joins my lab to make her missing lab, and I end up having to stay late?? I am tired of 20 year old immature kids not understanding that they will be in our shoes. This isn't about immaturity. It is about being human beings. Someone has to have babies. Doesn't mean I can't be a doctor too. Vent over. Off my soapbox now.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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